Oral health is critically important to children's overall health and represents the largest unmet health need for children. With the Surgeon General's 2000 report on oral health, there has been a growing awareness of the need to increase access to services and address racial/ethnic disparities in both service use and oral health status. Despite states'considerable efforts to address oral health and a few recent reports attempting to review selected state policies, little is known about the degree to which state policies affect children's oral health. The goal of the proposed study is to assess whether variations in state policies are related to children's oral health conditions and care utilization for children ages 1-17 years. The specific aims include: 1) To examine variations in state oral health policies in 2006. 2) To examine whether state oral health policies in 2006 are associated with state-level children's oral health and dental care utilization in 2007. 3)To examine whether state oral health policies in 2006 have an independent effect on children's oral health in 2007 after adjusting for individual child, family and state characteristics. Data for the proposed study come from: the 2007 National Survey of Children's Health (NSCH), the 2007 American Community Survey (ACS) conducted by the US Census, and from 2006 policy data compiled by the American Dental Association (ADA), the Children's Dental Health Project (CDHP), and the Association of State and Territorial Dental Directors (ASTDD) in collaboration with the Centers for Disease Control and Prevention (CDC). T-tests will be used to assess variations in the number and extent of state policies across states (Aim 1). Multivariable regression models will be constructed to consider relations between state policies with state- level oral health status and care use, conditioned on state characteristics (Aim 2). Multilevel regression models will be used to assess whether state policies have an independent effect on children's oral health after adjusting for individual child, family, and state characteristics. Age-specific policies will be examined for age subgroups (1-5, 6-11, and 12-17 years) (Aim 3). The proposed work will be the first study to link state policies to service use and children's oral health status, which supports NIDCR's Strategic Goal 1 (objective I-2: to increase the Institute's commitment to basic and applied research in the behavioral and social sciences) and Goal IV (objective IV-1: to identify the full range of factors that contribute to oral health inequality). Findings will inform prevention programs and policies that address children's oral health status and the emerging Healthy People 2020 oral health objectives. Our findings will also suggest whether selected provisions under Health Care Reform should be prioritized. PUBLIC HEALTH RELEVANCE: Oral health is critically important to children's overall health and represents the largest unmet health need for children. The goal of the proposed study is to assess the associations between state policies and children's oral health conditions and care utilization. Findings will inform prevention programs and policies that address children's oral health, the emerging Healthy People 2020 oral health objectives, and whether selected provisions under Health Care Reform should be prioritized.